NYC Cat Coalition Adoption Application

To be considered, application must be completely filled out unless questions do not apply.
Name of Cat(s) Requested *
Please indicate if you are open to adopting other cats if you are not applying for a specific cat.
Personal Information
Name*

First NameLast Name
Age*
Address*

Street

Apt #

City/State/ZipState / Province

Postal / Zip Code
Phone Number*

Home #Cell #
Email*
example@example.com
How long have you lived at this address?*
YesNo
Employer Name (company, self-employed, or individual employer)*
What is your Occupation/Title? *
Phone Number of Employer*
Contact of Employer *
(Manager, supervisor, etc)
Address of Employment*

Street

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
How long have you worked for this company?*

YearsMonths
Personal Information 2

Please fill out for spouse/partner
YesNo
Name*

First NameLast Name
Age*
Address

Street

Apt #

City/State/ZipState / Province

Postal / Zip Code
Phone Number*

Home #Cell #
Email*
How long have you lived at this address?*
(If less than 2yrs, please provide previous address)
YesNo
Employer Name (company, self-employed, or individual employer)*
What is their Occupation/Title?*
Address of Employment*

Street

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Phone Number of Employer *
Contact of Employer*
(Manager, supervisor, etc)
How long have they worked for this company?*

YearsMonths
Household Information
Previous or Secondary Residence
If you have lived at your current residence for less than 2 years, please include your previous address
OwnRent
When does your lease expire? *

MonthYear
YesNo
Name of Landlord or Renting Agent*
Phone Number of Landlord or Renting Agent *
Format: (000) 000-0000.
Are you adopting for yourself of someone else?*
YesNo
Why are you adopting a cat at this point and time?*
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
PetfinderAdopt-A-Pet.comRescueMe.orgOther
YesNo
If you have been with your current employer for 2 years or less, please provide the name of your previous employer
Address of Previous Employer
Phone # of previous employer
Format: (000) 000-0000.
What arrangements will you make for the care of your pet(s) while you are away on business or vacation?*
Personal Reference
Name*
Phone #*
Relationship*
(Friend, Sibling, Parent, Child, Colleague )
Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Back up Adopter

Who would take custody of your pet(s) IF for any reason you could no longer care for them?
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship *
(Friend, Sibling, Parent, Child, Colleague )
Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
YesNo
Household member 1
Name
Age
Relationship
(Child, Parent, Partner, Roomate)
Household member 2
Name
Age
Relationship
(Child, Parent, Partner, Roomate)
Household member 3
Name
Age
Relationship
(Child, Parent, Partner, Roomate)
Household member 4
Name
Age
Relationship
(Child, Parent, Partner, Roomate)
YesNo
How will you handle an animal entering your home?*
Pet History
YesNo
Dog(s)Cat (s)Other
Please specify*
(Hamster, bird, fish, etc)
How long did you have this pet?*

YearsMonths
Where is the pet now?*
If the pet was given away, why?*
Who did you give the pet to?*
YesNo
Please describe *
(Cat, dog, hamster, etc)
How many dogs have you owned?*
Please provide names, ages, and gender of dogs *

Names/AgesGender
How many cats have you owned? *
Please provide names, ages, and gender of cats*

Names/AgesGender
YesNo
YesNoAllSome
YesNo
When did you adopt from the Rescue/Organization?
(Approximate year is acceptable)
Name of Rescue/Organization
Phone# of Rescue/Organization
Format: (000) 000-0000.
Name of Pet adopted from Rescue/Organization
Preferences
YesNo
YesNo
Yes, Front Paws OnlyYes, Front and Back PawsNo
Indoors OnlyOutdoors OnlyIndoors and Outdoors
What type of food does/did your cat eat?*
Dry OnlyCanned OnlyBothOther
YesNo
YesNo
Describe what type of personality traits you want in a cat*
Veterinarian Information
YesNoPet(s) never saw Veterinarian
Name of Veterinarian/Clinic*
Name(s) of pet(s) seen by this Veterinarian/Clinic*
Phone Number of Veterinarian/Clinic*
Format: (000) 000-0000.
Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Who is the veterinarian you’ve used in the past?
Name of Veterinarian/Clinic:*
Name(s) of pet(s) previously seen by this Veterinarian/Clinic*
Phone Number of Veterinarian/Clinic*
Format: (000) 000-0000.
Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Please list any additional veterinarians that your cat(s) or dog(s) have seen that are not listed below.
I certify that all of the above information is true and accurate and I authorize the Representatives of NYC CAT COALITION to contact those listed above.

I understand that if I adopt a cat/kitten from the NYC Cat Coalition and it is later discovered that I have falsified any information on this Application, the adoption will be null and voice and I must return the cat/kitten(s) to the NYC Cat Coalition.

In order to be considered as an adopter, you MUST:
- Be 21 Years of Age or Older
- Provide identification showing your present address
- Have the knowledge and consent of your Landlord
Signature 1*

Clear
Date*

MonthDayYear
Date
Signature 2*

Clear
Date*

MonthDayYear
Date
Additional comments
Should be Empty:

Personal Information

Personal Information 2

Household Information

Personal Reference

Back up Adopter

Household member 1

Household member 2

Household member 3

Household member 4

Pet History

Preferences

Veterinarian Information